Search Results (4,333)

Background: Lower limb exoprostheses often lead to stump dermatological pathologies. The mechanisms by which mechanical microtraumas progress to non-healing ulcerative defects due to dysbiosis remain poorly understood. The objective of this study was to analyze mechanical, inflammatory, and infectious stump skin complications and justify the role of bacterial and mycological dysbiosis in blocking tissue regeneration. Methods: A critical narrative review guided by SANRA principles was conducted (PubMed/Scopus, 1980–2026). Data were extracted with a structured query focusing on amputation stumps, prosthetic interfaces, and skin/microbiological complications (dysbiosis, biofilms, and inflammatory markers). Evidence was graded using predefined clinical matrices and integrated through structured evidence collations to synthesize stump–prosthesis pathogenesis. The PRISMA method was not applied due to study heterogeneity. Results: Skin damage dynamics were categorized into three stages: adaptation (up to 12 months), chronic reactive changes (12–24 months), and late proliferative-infectious destruction (>24 months). The sealed liner space creates 100% humidity and alkalization (pH > 6.5). This causes a mycological shift, where resident Malassezia spp. lose dominance to invasive Candida albicans and non-dermatophyte molds (Aspergillus spp., Fusarium spp.). These pathogens form polymicrobial biofilms with Staphylococcus aureus. At the molecular level, delayed regeneration is driven by “frustrated phagocytosis”: macrophages, unable to engulf large fungal hyphae, continuously release reactive oxygen species and enzymes, trapping the wound in the inflammatory phase. Excessive matrix degradation and suppressed angiogenic factors further block epithelialization. Conclusions: The skin under a prosthesis socket forms a unique pathological biotope. Successful regeneration requires preventive mycobiota correction and targeted management of biophysical parameters (pH, humidity) within the “skin–liner” interface. Full article

Background: Motor and intellectual disabilities (MIDs) belong to a restricted and vulnerable social group with health restrictions for maintaining and preserving adequate oral health. Silver nanoparticles (AgNPs) have appeared as an encouraging therapy due to their excellent antimicrobial effects; however, scientific information on the antimicrobial effectiveness of AgNPs against bacteria in patients with MIDs remains limited. This study aimed to evaluate the antimicrobial substantivity of AgNPs in oral bacteria from patients with and without MIDs. Methods: Fifty-four oral biofilm samples were obtained from 26 participants with MIDs and 28 participants without MIDs. The microbial inhibition activity and the antimicrobial substantivity of AgNPs were determined. The antibiofilm activity of the AgNPs was explored using scanning electron microscopy (SEM). Results: The AgNPs displayed uniform size distributions (9.8 ± 1.7 nm) and electrical charges in surface particles that limit particle clustering (−39.8 ± 3.3 mV). The AgNPs were more effective than chlorhexidine (CHX) in eliminating bacteria from oral biofilms derived from both MID and non-MID patients (p < 0.05); therefore, the antimicrobial substantivity of the AgNPs was statistically better than deionized water but lower than CHX at specific exposure times (p < 0.05). The antimicrobial effectiveness of AgNPs at even low concentrations was associated with the type of oral biofilm, the type of antimicrobial solution, and, in some cases, gender. SEM images indicate a clear alteration in oral biofilm structure when AgNPs were applied. Conclusions: AgNPs exhibited significant potential to limit oral bacterial proliferation from microbial biofilms while contributing to the maintenance of oral condition in individuals with MIDs. Full article

Acinetobacter baumannii, particularly colistin-resistant strains, represents a major therapeutic challenge because of multidrug resistance, biofilm formation, and limited treatment options. This study investigated the antibacterial, antibiofilm, immunomodulatory, and therapeutic potential of Withania somnifera ethanolic root extracts (WSEEs) against drug-sensitive (DS) and colistin-resistant (CR) A. baumannii. WSEE exhibited concentration-dependent antibacterial activity, with MIC/MBC values of 125/250 μg/mL against the DS isolate and 250/500 μg/mL against the CR isolate. Time–kill analysis demonstrated bactericidal activity at 250 μg/mL, and WSEE significantly reduced the biomass of preformed biofilms. In cyclophosphamide-induced leukopenic mice, oral administration of WSEE (100 and 200 mg/kg) restored leukocyte counts and significantly reduced pulmonary bacterial burden following infection with both isolates. The higher dose (200 mg/kg) achieved survival rates of 90% and 70% in mice infected with the DS and CR isolates, respectively, compared with 50% and 30% in the corresponding colistin-treated groups. WSEE also significantly decreased serum levels of the pro-inflammatory cytokines, such as tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6), indicating attenuation of infection-associated inflammation. Biochemical analyses further showed that WSEE did not produce detectable hepatotoxicity or nephrotoxicity under the experimental conditions. Collectively, these findings demonstrate that WSEE possesses antibacterial, antibiofilm, anti-inflammatory, and immunomodulatory activities and provides therapeutic benefit in experimental A. baumannii infection. These results support the potential of WSEE as a complementary therapeutic strategy against multidrug-resistant A. baumannii, while further mechanistic, pharmacokinetic, and translational studies are needed to validate its clinical potential. Full article

The bacterial Quorum Sensing system refers to the recognition of signaling molecules called autoinducers produced by bacteria when a certain cell density is reached in the environment. Those cell-density-dependent autoinducers regulate and coordinate diverse functional processes, such as bioluminescence, biofilm production, sporulation, and even the expression of some virulence factors, among others. There is a wide variety of autoinducers, and for Gram-negative bacteria, the canonical autoinducers are the N-acyl-homoserine lactones (AI-1). Presently, the production of autoinducers in Leptospira has not been described; therefore, the objective of this study was to detect and identify autoinducers in this bacterial genus. We report here the expression of AI-1 in cultures ≥2.4 × 10⁸ of Leptospira meyeri. Ethyl acetate extracts of Leptospira culture supernatants were capable of activating the β-galactosidase system in the biosensor Agrobacterium tumefaciens strain NTL4. Partial identification of the leptospiral supernatant extracts was done by thin-layer chromatography (TLC), showing a similar retention factor to the synthetic standard N-Octanoyl-DL-homoserine lactone (C8-AHL) in the Leptospira supernatant extracts. In addition, infrared spectroscopy (IR) analysis showed peaks corresponding to the lactone and amide groups in both the C8-AHL standard and the Leptospira meyeri culture extracts. Moreover, High-Performance Liquid Chromatography–Mass Spectrometry (HPLC-MS/MS) confirmed the same retention time (10.7 ± 0.1 min) in both the Leptospira meyeri supernatant extracts and the C8-AHL standard. These results show that Leptospira meyeri synthesizes N-acyl homoserine lactone family autoinducers, particularly the N-Octanoyl-DL-homoserine lactone, and lay the groundwork for future research on Quorum Sensing systems in Leptospira. Full article

Pelargonium graveolens L’Hér. is a widely distributed aromatic plant that has been utilized in traditional medicine for an extended period. It is currently experiencing a surge in popularity in modern phytotherapy. The ethnopharmacological uses of this species include treatment of respiratory tract infections, digestive disorders, and analgesia. The plant’s multifaceted biological activity is attributed to the presence of monoterpenes, such as citronellol and geraniol, as well as non-volatile polyphenolic fractions and organic acids. Research has demonstrated the efficacy of PGEO (P. graveolens essential oil) in mitigating inflammation, a phenomenon attributable to the suppression of NF-κB and MAPK signaling pathways, as well as the inhibition of inflammatory mediators such as histamine, prostaglandins (PGs), and nitric oxide (NO). Furthermore, a broad spectrum of antimicrobial activity has been demonstrated against pathogens such as MRSA and Mycobacterium tuberculosis, whilst myricetin derivatives have been shown to enable the effective eradication of bacterial biofilms. It is also noteworthy that the oil’s components can reduce ACE2 receptor expression, indicating their potential to inhibit SARS-CoV-2 infection. Active compounds, such as geraniol, have been shown to modulate metabolic processes through interaction with LXR and FXR nuclear receptors. In addition, these compounds have been observed to exhibit spasmolytic effects within the gastrointestinal tract by blocking calcium channels. The influence on the HPA axis and the GABAergic system provides a scientific rationale for the plant’s traditional use in reducing stress and anxiety. Nevertheless, variations in chemical composition, determined by geographical origin, and an insufficient number of rigorous clinical data hinder the full medical implementation of this plant. It is imperative that further standardization of extracts and their verification in clinical trials is undertaken. Full article

Coptotermes formosanus is an economically significant termite species with a highly organised caste system, in which division of labour underpins colony function. Although gut microbiota is widely recognised for its roles in host nutrition and adaptation, much less is known about how these microbial communities are structured across castes. To explore caste-related gut bacterial variation in C. formosanus, we analysed the community structure of both workers and soldiers using high-throughput amplicon sequencing targeting the bacterial 16S rRNA gene. Although both castes were dominated by Bacteroidota and Spirochaetota, which together accounted for 78.87% to 85.78% in workers and 63.31% to 84.38% in soldiers, significant caste-associated differences were evident. Workers showed significantly higher bacterial richness, as indicated by observed ASVs, Chao1 indices, and Faith’s PD. Further clear caste-associated bacterial community was revealed by beta-diversity analysis. Differential taxonomic analysis revealed distinct caste-associated enrichment patterns. In addition, co-occurrence network analysis indicated a caste-associated interaction structure, with soldier-biased taxa forming a dense, highly connected module while worker-biased taxa contributed to local structure and bridging positions. Furthermore, chemoheterotrophy and fermentation were predicted to be enriched in workers, whereas nitrate reduction, aerobic chemoheterotrophy, aromatic compound degradation, and phenotypes related to biofilm formation, stress tolerance, and mobile elements were predicted to be relatively enriched in soldiers. Moreover, qPCR analysis further showed caste-associated differences in dominant gut protists, with Pseudotrichonympha in workers significantly higher than in soldiers and positively correlated with Azobacteroides. These results provide clear evidence of caste-associated differentiation in gut microbial composition and offer a foundation for identifying novel microbial targets for termite pest management. Full article

Background/Objectives: One-stage revision has become an increasingly accepted strategy for the treatment of chronic periprosthetic joint infection (PJI) of the knee in carefully selected patients. The use of a resorbable defensive antibacterial coating (DAC^® hydrogel) represents an attractive adjunct to reduce bacterial adhesion and biofilm formation on revision implants. However, evidence regarding its long-term performance is limited. Methods: We retrospectively reviewed 52 consecutive patients undergoing one-stage revision for knee PJI or an infected spacer between 2014 and 2023 using a standardized surgical and antimicrobial protocol including local application of DAC hydrogel loaded with vancomycin alone or vancomycin plus meropenem. Clinical, microbiological, and radiographic outcomes were evaluated. Infection-free survival was assessed using Kaplan–Meier analysis. Results: Forty-eight patients underwent revision for PJI and four for septic spacers. Four patients were unavailable for final evaluation. At follow-up of 7.7 ± 2.9 years (range 2.5–12.2 years), 47 of 48 clinically evaluable patients remained infection-free, corresponding to a crude infection-free proportion of 97.9%. Kaplan–Meier infection-free survivorship at 12 years was 98.1% (95% CI, 87.1–99.7%). Mean Knee Society Score improved from 47.7 to 84.4 points, while functional KSS improved from 41.9 to 82.9 points. Pain at rest decreased from 6.9 to 0.7 and pain during movement from 8.1 to 1.6 on the visual analogue scale. Conclusions: This series represents, to our knowledge, the longest reported follow-up of one-stage knee revision using the DAC hydrogel coating. The favorable outcomes observed with this hybrid fixation strategy support further investigation of this approach in larger, long-term, comparative multicenter studies. Full article

Environmental concerns regarding the ecotoxicological effects of antifouling biocides have led to the development of products targeting biofilm-forming bacteria. However, the potential for sublethal biocide exposure to promote bacterial adaptation and increase the risk of resistance development poses a potential threat to marine ecosystems and human health, yet it remains insufficiently understood. Although this study focuses on conventional antifouling biocides, the findings are intended to inform the future development and evaluation of both conventional and environmentally friendly antifouling technologies by highlighting the importance of assessing resistance induction at sublethal concentrations. In this study, the effects of three representative antifouling biocides on marine bacterial growth and bacterial adhesion were investigated. Sea-Nine 211 (DCOIT), copper sulphate (CuSO₄), and tributyltin oxide (TBTO; included as a historical reference compound due to its environmental persistence) were tested at four concentrations (0.01, 0.1, 1.0, and 10 µg/mL) against six marine biofilm-forming bacteria: Vibrio proteolyticus, V. aestuarianus, V. harveyi, V. natriegens, Shewanella putrefaciens and Pseudoalteromonas elyakovii. The results showed that Sea-Nine 211 exhibited a strong antibacterial effect at 10 µg/mL against all tested species except V. harveyi, whereas at the lowest concentration it promoted bacterial adhesion in V. proteolyticus. In contrast, TBTO and CuSO₄ showed limited antibacterial activity and increased microbial adhesion at the three lowest concentrations tested. These findings demonstrate that antifouling biocides can induce distinct responses depending on the concentration, ranging from growth inhibition to enhanced bacterial adhesion. Given that reducing biocide release has been proposed as a strategy to mitigate environmental impacts, our results highlight two potential challenges: (i) reduced antifouling efficacy at sublethal concentrations and (ii) an increased risk of bacterial adaptation associated with enhanced adhesion. To support future monitoring and resistance risk assessment, we propose a conceptual Resistance Risk Index (RRI) framework that could contribute to the sustainable management of antifouling agents while accounting for local environmental conditions. Full article

Bacterial colonization and biofilm formation on orthopedic and dental implants remain major clinical complications, while conventional systemic antibiotics are often limited by poor penetration into biofilms and infected bone. These limitations have motivated the development of biomaterials with intrinsic antibacterial activity. Hydroxyapatite (HA), a major inorganic component of bone and teeth, possesses excellent biocompatibility, osteoconductivity, and bone-bonding ability but exhibits limited inherent antibacterial activity. Incorporation of therapeutic metal ions, including Ag⁺, Cu²⁺, Zn²⁺, Ti⁴⁺, Co²⁺, Ga³⁺, Sr²⁺, and Ce³⁺, has therefore emerged as a promising strategy for developing multifunctional HA-based biomaterials. This review critically examines the crystal-chemical basis of metal-ion incorporation into HA and discusses how ionic radius, oxidation state, charge-compensation mechanisms, dopant concentration, and synthesis conditions influence lattice occupancy, physicochemical properties, and biological performance. The antibacterial activity of metal-substituted and metal-modified HA systems generally involves interconnected mechanisms, including bacterial membrane damage, intracellular metabolic disruption, interference with enzymes and nucleic acids, reactive oxygen species (ROS)-mediated oxidative stress, and inhibition of bacterial adhesion and biofilm formation. Ag-, Cu-, Zn-, and Ga-containing HA systems show the most consistently reported antibacterial effects, although their efficacy and cytocompatibility depend strongly on dopant concentration and ion-release kinetics. Co-substituted HA may combine antibacterial activity with angiogenic and osteogenic stimulation, whereas Sr-substituted HA is primarily osteogenic and anti-resorptive, with variable antibacterial performance. Ti-modified HA and TiO₂/HA composites exhibit predominantly photoactive antibacterial behavior, while Ce-substituted HA shows concentration-, oxidation-state-, and synthesis-dependent biological effects. The review also evaluates protein adsorption, osteogenic and angiogenic signaling, macrophage-mediated immunomodulation, biological safety, and representative commercial and translational applications. Overall, metal-substituted HA represents a versatile platform for infection-resistant and regenerative hard-tissue biomaterials, provided that composition, phase structure, ion release, antibacterial efficacy, and cytocompatibility are systematically co-optimized before clinical translation. Full article

Poor aqueous solubility remains one of the most persistent challenges in pharmaceutical development, limiting clinical translation and requiring innovative formulation strategies; approximately 40% of newly discovered pharmaceutical compounds are affected, underscoring the scale of the problem. Emulsion-based delivery systems overcome this limitation by maintaining drugs in a dissolved state, increasing absorption surface area, and enabling controlled release; however, conventional emulsions face thermodynamic instability and coalescence challenges. Cellulose and nanocellulose—cellulose nanocrystals (CNCs), cellulose nanofibers (CNFs), and bacterial cellulose (BC)—have emerged as sustainable, biocompatible alternatives to synthetic surfactants for stabilizing emulsions via Pickering mechanisms involving irreversible adsorption of solid particles at the oil–water interface. This review synthesizes 142 references across eight application themes: fundamentals and history, emulsion templating, drug encapsulation, antimicrobial and pathogen applications, vaccine adjuvants, topical and transdermal delivery, commercial translation, and regulatory gaps. Rather than treating all sources equally, 37 primary studies are examined in depth through structured critical-appraisal tables organized by system type, goal, key result, and limitation; the remainder are synthesized at the pattern level. A key mechanistic distinction is identified between BC as a standalone biomedical material (used in wound dressings, tissue scaffolds, and drug delivery membranes) and BC as a source for Pickering-emulsion stabilizers after disintegration into nanocrystals or nanofibrils. The review’s overall assessment is that the fundamental materials science of cellulose Pickering emulsions is mature and consistent across sources, while the translational evidence, including in vivo confirmation of drug release performance, biofilm-relevant antimicrobial testing, standardized nanocellulose characterization, and up-to-date intellectual property mapping, remains the binding constraint on clinical and commercial adoption. Six specific, evidence-linked research priorities are identified to advance cellulose emulsions toward regulatory approval and clinical use. Full article

Microplastics (MPs) can accumulate antibiotic resistance genes (ARGs) in seawater, but their effects on sediment resistomes and microbial communities across different marine sediments remain poorly understood. A 30-day incubation experiment using polyethylene (PE), polyethylene terephthalate (PET), and polyvinyl chloride (PVC) MPs and composite sediments from four marginal seas of China was conducted. PE exposure significantly increased nearly all the abundances of intI1, sul1, tetA, and bla_TEM in all four sediment sources (Bohai, Yellow, East China, and South China Seas), whereas PET and PVC produced sediment-dependent responses. PE-associated biofilms may provide protective niches that favor bacterial growth and ARG enrichment, while PET and PVC may exert inhibitory effects in some sediments. MP exposure was also associated with shifts in bacterial community composition and alpha diversity. Co-occurrence analysis identified Alcanivorax, Methylophaga, and Brevirhabdus as potential hosts associated with all target genes, whereas Idiomarina showed potential associations with tetA and bla_TEM. Overall, the results indicate that MP effects on sediment ARGs and bacterial communities depend on both polymer type and sediment characteristics. Because the experiment used a high MP loading and carbon supplementation, further studies at environmentally relevant concentrations are needed to evaluate the ecological implications. Full article

Eucalyptus bacterial wilt in China, caused predominantly by Ralstonia pseudosolanacearum, severely threatens Eucalyptus plantation management in China and demands plant-derived alternatives to conventional bactericides. This study evaluated the in vitro antibacterial activities and underlying molecular mechanisms of two differentially substituted coumarin derivatives, daphnetin (DAP) and 6-methylcoumarin (MC), against a eucalyptus-derived R. pseudosolanacearum strain. The minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) were determined using broth microdilution assays. Quantitative phenotypic assays were conducted to evaluate the effects of sub-lethal concentrations on biofilm formation, swimming motility, and extracellular polysaccharide (EPS) accumulation. Furthermore, high-throughput RNA sequencing integrated with GO and KEGG enrichment analyses was employed to characterize the genome-wide transcriptomic responses. Antimicrobial susceptibility testing demonstrated that DAP possessed superior bactericidal efficacy, yielding lower MIC (62.5 μg/mL) and MBC (250 μg/mL) values than MC. Conversely, sub-lethal MC exhibited a more pronounced, early-stage suppression of flagellum-dependent swimming motility and biofilm maturation. Both compounds consistently attenuated EPS production. Transcriptomic analysis revealed distinct yet partially convergent regulatory networks: DAP primarily exerted metabolic strangulation by downregulating genes governing aerobic respiratory chains and peripheral carbon/nitrogen pathways, whereas MC targeted collective behavior and active pathogenesis, systematically downregulating the expression of genes associated with flagellar assembly, quorum sensing, and Type III and VI secretion systems. Notably, both pathways converged downstream to repress the master virulence regulator xpsR and the epsA-P operon. These findings provide valuable insights into the potential molecular pathways affected by DAP and MC, offering a useful reference for future exploration of botanical formulations for ecologically responsible forest disease control. Full article

Bacterial vaginosis (BV) and aerobic vaginitis (AV) are usually described as distinct forms of vaginal dysbiosis. BV is characterized by depletion of lactobacilli, overgrowth of anaerobic microorganisms, and biofilm formation, whereas AV is associated with inflammatory changes, epithelial disruption, and predominance of aerobic bacteria. Over the past two decades, this distinction has profoundly influenced the understanding, diagnosis, and management of vaginal disorders. Despite their apparent differences, the relationship between BV and AV remains incompletely understood. Growing evidence indicates that many women exhibit microbiological and microscopic patterns that cannot be readily classified within existing diagnostic frameworks. Intermediate Nugent scores, mixed vaginitis, transitional ecological states, post-treatment microbiota reconstitution, physiological hypoestrogenic conditions, and uncommon inflammatory patterns all challenge the traditional view of BV and AV as strictly separate entities. This narrative review examines the historical evolution of BV and AV concepts, compares their microbiological, immunological, and epithelial characteristics, and evaluates the diagnostic paradigms currently used to identify vaginal dysbiosis. The strengths and limitations of clinical and diagnostic approaches are discussed together with the extent to which contemporary international guidelines reflect current biological knowledge. Particular emphasis is placed on intermediate, mixed, and overlapping states that blur the boundaries between established diagnostic categories. The available evidence supports the clinical usefulness of distinguishing BV and AV as separate clinicopathological entities. However, it also indicates that vaginal ecosystem disturbances frequently extend beyond rigid dichotomous classifications. Current diagnostic categories remain valuable tools for clinical practice, yet they may only partially capture the complexity and dynamic nature of vaginal dysbiosis. Understanding how microbial communities, host responses, epithelial integrity, and physiological factors interact remains a major challenge for future research and clinical interpretation. Full article

New beta-lactam/beta-lactamase inhibitor combinations (BL/BLICs) are licensed for Klebsiella pneumoniae carbapenemase (KPC)-producing Klebsiella pneumoniae (KPC-Kp) infections. However, data regarding their efficacy against bacterial biofilms and the potential of synergistic combinations remain limited. This study evaluated their efficacy on planktonic and biofilm forms of KPC-Kp isolated from catheter-related bloodstream infections (CRBSIs), correlating findings with genomic and clinical data. Twelve KPC-3-harboring isolates (ST512, n = 7; ST307, n = 3; ST101, n = 2) were characterized via whole-genome sequencing. Ceftazidime/avibactam (CAZ/AVI), meropenem/vaborbactam (MEM/VAB), and imipenem/relebactam (IMI/REL) were tested alone or combined with fosfomycin (FOS), cefepime (FEP), meropenem (MEM), or imipenem (IMI) using checkerboard assays. All BL/BLICs alone showed significant, comparable efficacy against biofilm-producing strains. However, combination testing revealed heterogeneous synergistic profiles. CAZ/AVI combined with MEM, IMI, or FEP achieved 100% synergy in both planktonic and biofilm states. MEM/VAB-based combinations demonstrated consistent synergy (50–100%), whereas IMI/REL showed higher synergistic rates in biofilm than in planktonic forms. Conversely, FOS-based regimens were significantly less effective against biofilms. These findings provide a clinical rationale for selecting optimized dual regimens to eradicate biofilms, offering a critical therapeutic strategy to preserve vascular devices when catheter removal is unfeasible. Full article

Helicobacter pylori is one of the most common bacterial pathogens in humans and the primary etiological agent of chronic gastritis, peptic ulcer disease, and gastric cancer. Its ability to establish persistent gastric colonization relies on multiple virulence factors, including adhesins, urease, cytotoxins, motility, outer membrane vesicles, and biofilm formation, which collectively promote bacterial survival, chronic inflammation, and treatment failure. The increasing prevalence of antibiotic-resistant H. pylori strains has intensified the search for therapeutic strategies targeting both bacterial viability and virulence. Berberine (BBR), a natural isoquinoline alkaloid, has emerged as a promising candidate because of its antibacterial, anti-inflammatory, and antioxidant properties. Increasing evidence derived from native berberine, its derivatives, and berberine-based formulations indicates multifaceted anti-H. pylori activity, including direct antibacterial effects, inhibition of virulence determinants, and modulation of host inflammatory responses. This review summarizes current knowledge on the epidemiology and pathogenic mechanisms of H. pylori and provides a comprehensive overview of the available evidence regarding the anti-H. pylori pharmacological profile of BBR-based compounds. Particular attention is given to their effects on bacterial adhesion, motility, urease activity, efflux pump function, biofilm formation, and host inflammatory signaling pathways. The review also discusses findings from preclinical and clinical studies supporting BBR-based strategies as adjuncts to conventional eradication therapies. In addition, recent advances in nanotechnology-based drug delivery systems designed to overcome the poor oral bioavailability of BBR and improve its therapeutic efficacy against H. pylori are highlighted. Full article